Three days of death and disorder: A Montreal orderly’s diary from a nursing home’s coronavirus outbreak

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Elderly people have taken the brunt of the impact of the COVID-19 outbreak, especially those residing in seniors’ homes or long-term care centres. Canada’s first death from the new illness was recorded at the Lynn Valley Care Centre in North Vancouver, where 18 residents have now died. Facilities such as the Pinecrest Nursing Home in Bobcaygeon, Ont., with 29 deaths, or Résidence Herron, in Dorval, Que., with 31 deaths, have become grim examples of the toll exacted by the pandemic.

The outbreak hit hard at Centre d’hébergement LaSalle, a Montreal centre where as of Tuesday, 77 elderly residents were infected and 26 had died.

Terrie Laplante-Beauchamp witnessed the storm that hit the LaSalle facility. A 32-year-old University of Montreal master’s student in microbiology and immunology, she had trained and worked as an orderly a decade ago. She volunteered to help as an orderly again during the outbreak.

The following is her diary during three days when she worked at LaSalle, between April 3 and 5. A few days later, she developed a fever and had to take a test for potential exposure to the new coronavirus. On Tuesday night, she received a call informing her that the hospital lost her test sample. She spent the evening getting swabbed again. If the result is negative, she plans to help again for as many days as she can until the end of the crisis.

-Introduction and translation by Tu Thanh Ha

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Day 1

I start my first shift at 3:30 p.m., with no training or orientation session. When I show up at the nursing home, the co-ordinator for the day seems confused.

It is then I realize I have been assigned to the COVID-19 positive floor. I’m new, and I’m being sent to the floor that requires experienced staffers. The co-ordinator gives me no directives regarding hygiene policies or the use of personal protective equipment. I ask him to supply me with an N95 respirator, but he says he is not able to do that.

On my floor, we are three orderlies for 35 patients, including 21 who tested positive for COVID-19. The most experienced of the three of us has worked part-time for a while. The other started the day before and is very anxious, because she isn’t familiar with the directives either and she has just been transferred to this floor. During the shift, I will find her in tears at the nursing station.

At the start of my first shift, there is no nursing staff meeting. We don’t know the routines of the patients nor their level of mobility or autonomy. We are given no directives.

So we take our cues from the more experienced orderly. On the right aisle are 11 rooms of COVID-19 infected patients “separated” by a plastic sheet. On the left aisle are 24 rooms with five COVID-19 positive residents. Their rooms aren’t grouped together but are dispersed among those of uninfected patients.

Before entering a room where there’s an infected patient, we are supposed to put on an isolation gown, gloves, a mask and a face shield. When we leave, we must throw away the gown, mask and gloves, and disinfect our hands.

The more experienced orderly admonishes me for following those steps. I tell her this is what has to be done but she says we won't have enough time.

She takes several breaks during work, and disappears a few times without telling us. She is so overwhelmed by dealing with the outbreak in this nursing home that she seems to have lost her humanity. She barely speaks to the patients, lacks tactfulness and shows little empathy. She lets the call bells ring and gets cranky at each request for help because she can’t take it any more.

After the residents’ supper, I take a few minutes to rest and sit in the kitchen. Ms. A, a patient with very mild dementia, comes to see me. “You look really tired. I noticed you haven’t had dinner yet, you should have something to eat,” she said.

She stays with me during the meal and tells me a bit about her life, then talks about her concerns about the pandemic. She tells me she is tired of being confined to her room and wants to "leave" as quickly as possible.

At the end of my shift, I go home for a short night of sleep, because the next day, a double shift (7:30 a.m. to 11:30 p.m.) on the same floor awaits.

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Day 2

When I get to the floor, I notice that the nurses seem worried. I am told that of the five orderlies who must work today, I am the only one they could find. The co-ordinator will have to reassign workers from other floors.

The residents are impatient and agitated by all the upheaval to their routine and share their frustrations with me.

Ms. B, the centre's youngest resident, tells me that she hasn't had a full bath for weeks, and that her bed hasn't been changed either. We only wash her face, armpits and private parts. All other residents are in the same predicament.

Ms. S, an 87-year-old patient, keeps saying how much she wants to die, how much she is tired of loneliness and confinement, how her loss of autonomy is driving her crazy and how she no longer feels a reason to live.

She cries and asks for a hug, but I can’t risk infecting her, even if that breaks my heart. I kneel in front of her wheelchair, grab her hands and try to reassure her, telling her that I will be there to help her through, that she can ring the bell if she needs anything. She thanks me profusely. She will die suddenly a few days later.

Several other patients are severely depressed and harbour dark thoughts. They tell me “I want to die, let me die in peace, I’m dying, I can’t take it any more.”

Some patients flatly refuse to eat and are in decline. Those who need to walk daily, or to get up and go to the bathroom with assistance, in order to maintain their autonomy, are confined to their bed and must wear a diaper. Patients who require full help when eating often can’t finish their meals, because orderlies run out of time. Most are dehydrated because orderlies have little or no time to dispense water or juice during their shift. The residents have greasy hair, their nails are dirty and long, their clothes are soiled and reused daily. Oral hygiene is not carried out. Their rooms aren’t cleaned and fruit flies buzz everywhere. The place reeks of neglect.

Mr. H is in terrible shape. His TV no longer works and he has nothing to distract him. He has no phone, no radio, no book. He lets himself go, no longer cleans himself and no longer shaves his beard. "What for?" he tells me.

At the nursing station, the phone rings endlessly. Families of those who don’t have a phone in their room are seeking updates about them. The nurse tells me not to answer the calls, because it never ends, there is no time. I dare not imagine the anxiety of families who have no news of their loved ones. I still take a few calls.

The daughter of Ms. N, who tested positive for COVID-19, asks me for news. She is not doing well, she is at the end of her life. Another family phones to tell me that their mother, also infected with the virus, does not answer the phone. The patient has reduced mobility; she is not able lift the handset. I help her so that she can communicate with her family.

The family of Ms. F, an infected patient, shows up at her window. We can’t open the window for them; they are powerless in front of their unconscious mother, who breathes haltingly. I see the worries in their eyes and I am torn apart. Ms. F will die that same evening.

During my evening shift, two infected patients on my floor die. Their families are devastated that they couldn’t be at their bedside during their last moments, a lonely death.

The arrival of new nurses results in some unintentional neglect of the residents. Ms. V is at an advanced stage of muscular dystrophy and needs full assistance. The nurse leaves her medication, including the painkillers, on the bedside table rather than handing it to her. During my last round, I find Ms. V in extreme pain. But she has a heart of gold. She says she understands the situation and does not blame us. She knows we are overwhelmed and that we are doing our best.

During the day shift, I see the orderlies assigned to infected residents walking around the corridors in soiled personal protective equipment. They are protecting themselves, but not other people. They say they were told not to remove their gear if they enter contaminated rooms in the two corridors.

At around 10 p.m., the other two orderlies decide to leave earlier than scheduled. So I am left alone with the patients until 11:30 p.m. The bells ring, and I have to move between infected and uninfected rooms.

I get home around midnight and have trouble climbing the steps to my apartment. I'm exhausted and I'm starting to be very anxious about the nearly non-existent handling of the outbreak in this centre.

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Day 3

After only a few hours of sleep, I start my second double shift at 7:30 am. Three orderlies are missing.

The patients aren’t receiving all the help they need because most of us are new, so we’re unpractised and slow.

The impact of the outbreak hits me hard. It’s Ms. P’s birthday, but she can’t celebrate with her loved ones. Her daughter shows up at her window with a big sign wishing her happy birthday, but Ms. P is in a wheelchair and can barely see her. She talks on the phone with her daughter and the two cry.

Ms. H's daughter is at her window, in the rain, and is trying to incite her to eat. Her mother has declined a lot in the past few weeks. She is semi-conscious and eats very little. We turn her bed toward the window, but she doesn't respond to her daughter's voice.

Ms. O was transferred at the start of the pandemic and has no personal belongings except a pair of socks. She tested positive for COVID-19 and suffers from dementia. She is constantly trying to escape from the floor, walking on her soiled socks. She shouts "Help me, I don't want to die, I want to go home, please help me, I'm sorry." Patients with dementia think we are intentionally ignoring them.

Another infected patient is trying to get out of the containment area, I have to tell him to return to his room. When he turns around, I notice that his gown is stained with blood. Patients confined in their small rooms have nothing to do but lie down and many develop bed sores.

Keeping patients in their rooms prevents them from getting the minimum amount of exercise they need daily. As a result, most are in free fall in their loss of autonomy and have nothing to do all their day but be alone and depressed in their rooms.

Around noon, I look for the co-ordinator of the day, because I don’t feel well. I have hot flashes, the sweat running down my forehead stings my eyes, I have trouble walking, I am exhausted and my back hurts a lot. I can’t find her. I look for her a few more times during the rest of the day. Then the nurse tells me that the co-ordinator left hours ago. So it seems no one has been in charge of the facility, when there should be someone at all times. We are left to our own devices.

That is the moment I realize the scale of this situation. From what I can tell, the big jump in COVID-19-positive cases at this centre is caused by employees who are not given hygiene policies to follow. No plan of action to mitigate transmission has been put in place or communicated to employees. The employees aren’t properly protected and don’t earn enough to risk their mental and physical health.

Some employees take advantage of the absence of direction and, without notice, don’t show up for work, or take many breaks when they can’t handle it any more. They are afraid of catching the virus, afraid of spreading it to their loved ones, their children. They see their patients die one after the other. I don’t blame them, they need to be comforted, to be adequately protected and guided by management.

The handling of the COVID-19 crisis has enormous shortcomings that should have been eliminated weeks ago. First, avoid moving employees between floors or facilities. Similarly, not keeping positive and negative patients in the same aisle would likely have reduced the risk of spreading the virus. Reiterating the isolation directives at the start of each shift, posting them in the centre and providing adequate personal protective equipment would have greatly reassured the health care personnel. Providing a phone line to patients, distributing books or other entertainment material, using donations from the public if necessary, would have reduced the loneliness and feeling of abandonment of the residents.

I tip my hat to the nursing staff, especially the orderlies, who are doing their best under the circumstances. I also tip my hat to the residents, who have shown such understanding and empathy toward the staff, and who often cheer us up when our morale is low.

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Official response

The Globe and Mail asked the local health authority responsible for the LaSalle facility, the Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Ouest-de-l'Île-de-Montréal, for a response to Ms. Laplante-Beauchamp’s diary.

Without commenting directly on her observations, the CIUSSS detailed a number of steps that had been taken since April 9, four days after Ms. Laplante-Beauchamp had worked at LaSalle.

In a statement, the CIUSSS said the facility was inspected on April 9 and, since then, personal protective equipment was ordered and made available for employees, guidelines were posted and residents with confirmed infections have been transferred to a separate zone.

“The level of care is now up to date” after another checkup on April 11, the statement said.

“CIUSSS de l’Ouest-de-l'Île-de-Montréal will not spare any efforts to apply all preventive steps recommended by the Health and Social Services Department and Public Health Department to insure the health and safety of patients and employees.”

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